Psychological Development, Disorders, and Treatments, Exams of Nursing

Download Psychological Development, Disorders, and Treatments and more Exams Nursing in PDF only on Docsity! PMHNP Certification Examination test and correct answers for the 2024 candidates 1. Tar as off Principle - Correct 1976 - duty to warn victims of potential harm from client 2. Deontological Theory - Correct Ethical theory that states an action is judged as good or bad based on the act itself regardless of the consequences 3. Teleological Theory - Correct Ethical theory that states an action is judged as good or bad based on the consequence or outcome 4. Virtue ethics - Correct ethical theory that states actions are chosen based on the moral virtues (eg. honesty, courage, compassion, wisdom, gratitude, self-respect) or the character of the person making the decision 5. Erikson's developmental stage infancy age range - Correct birth-1 year 6. Erikson's developmental stage infancy developmental tasks - Correct trust vs. mistrust 7. Erikson's developmental stage infancy indications of developmental mastery - Correct Ability to form meaningful relationships, hope about the future trust in others 8. Erikson's developmental stage infancy indication of developmental failure - Correct poor relationships, lack of future hope, suspicious of others 9. Erikson's developmental stage early childhood age - Correct 1-3 yo 10. Erikson's developmental stage early childhood developmental task - Correct autonomy vs. shame and doubt 11. Erikson's developmental stage early childhood indications of developmental mastery - Correct self-control, self-esteem, willpower 12. Erikson's developmental stage early childhood indications of developmental failure - Correct poor self-control, low self esteem, self-doubt, lack of independence 13. Erikson's developmental stage late childhood age - Correct 3- 6yo 14. Erikson's developmental stage late childhood developmental task - Correct initiative vs guilt 15. Erikson's developmental stage late childhood indications of developmental mastery - Correct self-directed behavior, goal formation, sense of purpose 16. Erikson's developmental stage late childhood indications of developmental failure - Correct lack of self-initiated behavior, lack of goal orientation 17. Erikson's developmental stage school-age ages - Correct 6- 12yo 18. Erikson's developmental stage school-age developmental task - Correct industry vs. inferiority 19. Erikson's developmental stage school-age indications of developmental mastery - Correct ability to work; sense of competency and achievement 20. Erikson's developmental stage school-age indications of developmental failure - Correct sense of inferiority, difficulty with working, learning 51. Major Depression typical age onset - Correct late adolescence to young adulthood 52. dementia typical age onset - Correct most common after age 85 53. Freud's Id - Correct -contains primary drives or instincts 54. -drives are largely unconscious 55. -operates on the pleasure principle 56. -"I want" 57. pleasure principle - Correct the id seeks immediate satisfaction 58. freud's ego - Correct -rational mind, logical and abstract thinking 59. -"I think, I evaluate" 60. Freud's superego - Correct -sense of conscience or right vs wrong 61. -develops around age 6 62. -"I should or ought" 63. Freud's psychosexual stage of development oral stage age - Correct 0-18 months 64. Freud's psychosexual stage of development oral stage primary means of discharging drives and achieving gratification - Correct sucking, chewing, feeding, crying 65. Freud's psychosexual stage of development oral stage psych disorder linked to failure of stage - Correct schizophrenia, substance abuse, paranoia 66. Freud's psychosexual stage of development anal stage age - Correct 18 months-3 years 67. Freud's psychosexual stage of development anal stage primary means of discharging drives and achieving gratification - Correct sphincter control, activities of expulsion and retention 68. Freud's psychosexual stage of development anal stage psych disorder linked to failure of stage - Correct depressive disorder 69. Freud's psychosexual stage of development phallic stage age - Correct 3-6 years 70. Freud's psychosexual stage of development phallic stage primary means of discharging drives and achieving gratification - Correct exhibitionism, masturbation with focus on Oedipal conflict, castration anxiety, and female fear of lost maternal love 71. Freud's psychosexual stage of development phallic stage psychiatric disorder linked to failure of stage - Correct sexual identity disorders 72. Freud's psychosexual stage of development latency stage age - Correct 6years-puberty 73. Freud's psychosexual stage of development latency stage primary means of discharging drives and achieving gratification - Correct peer relationships, learning, motor-skills development, socialization 74. Freud's psychosexual stage of development latency stage psych disorder linked to failure of stage - Correct inability to form social relationships 75. Freud's psychosexual stage of development genital stage age - Correct puberty forward 76. Freud's psychosexual stage of development genital stage primary means of discharging drives and achieving gratification - Correct integration and synthesis of behaviors from early stages, primary genital-based sexuality 77. Freud's psychosexual stage of development genital stage psych disorder linked to failure of sage - Correct sexual perversion disorders 78. Cognitive Theory - Correct -Piaget a. four stages of development 79. Piaget developmental stage sensorimotor age - Correct birth-2 years 80. Piaget developmental stage sensorimotor - Correct the critical achievement of this stage is object permanence 81. Piaget developmental stage preoperational age - Correct 2-7 years 82. Piaget developmental stage preoperational - Correct more extensive use of language and symbolism 83. magical thinking 84. Piaget developmental stage concrete operations age - Correct 7-12 years 85. Piaget developmental stage concrete operations - Correct child begins to use logic 86. develops concepts of reversibility and conservation 87. Piaget developmental stage formal operations age - Correct 12 years-adult 88. Piaget developmental stage formal operations - Correct ability to think abstractly 89. thinking operates in a formal, logical manner 90. interpersonal theory - Correct -Harry Stack Sullivan 91. -self-system 92. -when the person's need for satisfaction and security is interfered with by the self system, mental illness occurs 93. -humans experience anxiety and bx is directed toward relieving the anxiety, which then results in interpersonal security 94. self system - Correct interpersonal theory 95. total components of personality traits 142. -motivation is elicited from the client 143. -nonconfrontational, nonadversarial 144. self-efficacy and social learning theory - Correct -albert bandura 145. -behavior is the result of cognitive and environmental factors 146. theory of cultural care - Correct -madeline Leininger 147. -regardless of the culture, care is the unifying focus and the essence of nursing 148. theory of self-care - Correct Dorothy orem 149. -self care 150. therapeutic nurse-client relationship theory or interpersonal theory - Correct Hildegard Peplau 151. -first significant psych nursing theory 152. -sees nursing as an interpersonal process in which all interventions occur within the context of the nurse-client relationship 153. phases of the nurse-client relationship - Correct -orientation 154. -working phase (identification, exploration) 155. -termination phase (resolution) 156. caring theory - Correct jean Watson 157. caring is an essential component of nursing 158. t test - Correct assesses whether the means of two groups are statistically different from each other 159. analysis of variance (ANOVA) - Correct tests the difference among three or more groups 160. pearson's r correlation - Correct tests the relationship between two variables 161. probability - Correct likelihood of an event occurring 162. lies between 0 and 1 163. an impossible event has probability of 0 164. a certain event has a probability of 1 165. P value - Correct aka level of significance describes the probability of a particular result occurring by change alone 166. if P=0.1, there is a 1% probability of obtaining a result by chance alone 167. Donabedian model - Correct structure, process, outcome 168. process of quality improvement PDSA cycle - Correct Plan 169. Do 170. Study 171. Act 172. monoamines - Correct -biogenic amines 173. -dopamine 174. -norepinephrine 175. -epinephrine 176. -serotonin 177. dopamine - Correct -catecholamine 178. -produced in the substantia nigra and ventral tegmental area 179. -precursor is tyrosine 180. -removed from synaptic cleft by monoamine oxidase (MAO) enzyme action 181. -D1-like and D2-like receptors 182. four dopaminergic pathways - Correct -mesocortical 183. -mesolimbic 184. -nigrostriatal 185. -tuberoinfundibular 186. norepinephrine - Correct -catecholamine 187. -produced in the locus ceruleus of the pons 188. -precursor is tyrosine 189. -major neurotransmitter implicated in mood, anxiety, and concentration disorders 190. -Alpha 1 and 2 receptors 191. epinephrine - Correct -catecholamine 192. -produced by the adrenal glands 193. -referred to as the adrenergic system 194. serotonin - Correct -known as an indole 195. -produced in the raphe nuclei of the brainstem 196. -precursor is tryptophan 197. -major neurotransmitter implicated in mood and anxiety disorders 198. -5HT1a, 5HT1d, 5HT2, 5HT2a, 5HT3, 5HT4 receptors 199. amino acids - Correct glutamate, aspartate, gamma- aminobutyric acid (GABA), glycine 200. glutamate - Correct -universal excitatory neurotransmitter 201. -major neurotransmitter involved in process of kindling (implicated in sz dx and bipolar dx) 202. -imbalance implicated in mood dx and schizophrenia 203. -AMPA and MNDA receptors 204. aspartate - Correct another excitatory neurotransmitter 205. -works with glutamate 206. GABA - Correct universal inhibitory neurotransmitter 207. -site of action of benzos, alcohol, barbiturates, and other CNS depressants 208. -GABAa and GABAb receptors 209. glycine - Correct -another inhibitory neurotransmitter 210. -works with GABA 211. cholinergics - Correct acetylcholine 212. acetylcholine - Correct synthesized by the basal nucleus of Meynert 213. -precursors are acetylcoenzyme A and choline 214. -nicotinic and muscarinic receptors 215. neuropeptides - Correct -nonopioid type (substance P, somatostatin) 216. -opioid type (endorphins, enkephalines, dynorphins) 217. -modulate pain 262. glutamate symptoms of deficit - Correct poor memory, low energy, distractible 263. learning difficulty, negative symptoms of schizophrenia 264. glutamate symptoms of excess - Correct kindling, seizures, anxiety or panic 265. bipolar affective disorder, psychosis from ischemic neurotoxicity or excessive pruning 266. peptides opioid type general function - Correct modulate emotions, reward center function, consolidation of memory, modulate reactions to stress 267. peptides opioid type symptoms of deficit - Correct hypersensitivity to pain and stress 268. decreased pleasure sensation 269. dysphoria 270. substance abuse 271. peptides opioid type symptoms of excess - Correct insensitivity to pain 272. catatonic-like movement disturbance 273. auditory hallucinations 274. decreased memory 275. structural imaging - Correct provides evidence of size and shape of anatomical structure 276. -computed tomography CT 277. -Magnetic resonance imaging MRI 278. computed tomography CT - Correct provides a three- dimensional view of the brain structures 279. -differentiates structures based on density 280. provides suggestive evidence of brain-based problems but not specific testing for psychiatric disorders 281. -advantage: widely available, relatively inexpensive 282. -disadvantage: lack of sensitivity, cannot differentiate white matter from gray mater; cannot view structures close to the bone tissue; underestimation of brain atrophy, inability to image sagittal and coronal views 283. magnetic resonance imaging (MRI) - Correct provides a series of 2D images that represent the brain 284. -advantages: can view brain structures close to the skull and can separate white matter from gray matter; readily available; resolution of brain tissue superior to CT scanning 285. -disadvantages: expensive, many contras to use, claustrophobia 286. Functional imaging - Correct measures function of areas of the brain and bases the resulting assessment on blood flow 287. -may use radioactive pharmaceuticals to cross blood-brain barrier 288. -mainly used for research 289. -EEG and evoked potentials testing 290. -magnetoencephalography MEG 291. -single photon emission computed tomography SPECT 292. -positron emission tomography PET 293. EEG and evoked potentials testing - Correct least expensive test 294. convey info on electrical functioning of CNS 295. Magnetoencephalography MEG - Correct similar to EEG 296. detects different electrical activities 297. used in complementary fashion with EEG testing 298. single photon emission computed tomography (SPECT) - Correct information of cerebral blood flow 299. limited available 300. expensive 301. positron emission tomography PET - Correct images of brain when positron-emitting radionuclei interact with an electron 302. expensive 303. combined structural and functional testing - Correct examine structure in conjunction with function 304. mainly for research 305. functional MRI fMRI 306. 3D, event realted functional MRI 3fEMRI 307. Fluorine magnetic spectroscopy 308. Dopamine D2 receptor binding 309. genetic testing FDA required in people of Asian descent - Correct presence of HLA-B*1502 allel 310. inherited variant of HLA-B gene 311. prior to prescribing carbamazepine d/t risk of steven Johnson syndrome and toxic epidermal necrolysis TEN 312. normal BMI - Correct 20-25 313. overweight BMI - Correct 26-29 314. obese BMI - Correct 30-35 315. what to watch for if on psychtropics such as carbamazepine (Tegretol) or clozapine - Correct elevated temp 316. agranulocytosis 317. steven Johnson syndrome med risk - Correct carbamazepine or lamotrigine 318. blurry vision side effect in psychotropics - Correct anticholinergic side effect 319. Seroquel may cause cataracts 320. what can both lithium and anorexia nervosa cause - Correct peripheral edema 321. Free thyroxine T4 normal levels - Correct 0.8-2.8ng/dL 322. interfering factors of Free T4 - Correct values can be increased during tx with heparin, aspirin, and propranolol 323. values can be decreased during tx with furosemide (Lasix) or Methadone 365. agonist effect - Correct Drug binds to receptors and activates a biological response 366. inverse agonist effect - Correct Drug causes the opposite effect of agonist; binds to same receptor 367. partial agonist effect - Correct drug does not fully activate the receptors 368. antagonist effect - Correct Drug binds to the receptor but does not activate a biological response 369. schedule 1 drugs - Correct nonmedicinal substances 370. high abuse potential 371. used for research only 372. not available by prescription 373. heroin and marijuana 374. typical antipsychotics - Correct haloperidol (Haldol), haloperidol deconate (Haldol deconate) 375. loxapine (loxitane) 376. thioridazine (mallaril) 377. thiothixene (navane) 378. fluphenazine (prolixin), fluphenazine deconate (prolixin doconate) 379. mesoridazine (serentil) 380. trifluoperazine (stelazine) 381. chlorpromazine (thorazine) 382. perphenazine (trilafon) 383. second generation antipsychotics - Correct clozapine (Clozaril) 384. ziprasidone (Geodon) 385. risperidone (Risperdal) 386. quetiapine (Seroquel) 387. olanzapine (Zyprexa) 388. aripiprazole (abilify) 389. paliperidone (Invega) 390. iloperidone (fanapt) 391. asenapine (saphris) 392. lurasidone (luatuda) 393. mood stabilizers - Correct valproic acid (depakene) 394. divalproex sodium (Depakote) 395. lithium carbonate (eskalith, lithobid, lithonate, lithotabs) 396. lamotrigine (lamictal) 397. carbamazepine (tegretol) 398. carbamazepine ER (equetro) 399. oxcarbazepine (Trileptal; off label) 400. Tricyclics - Correct clomipramine (anafranil) 401. amoxapine (asendin) 402. amitriptyline (Elavil) 403. desipramine (norpramin) 404. nortripyline (pamelor) 405. doxepin (sinequan) 406. trimipramine (surmontil) 407. imipramine e(tofranil) 408. protriptyline (vivactil) 409. Serotonin selective reuptake inhibitors SSRIs - Correct citalopram (celexa) 410. fluvoxamine (Luvox) 411. paroxetine (paxil) 412. paroxetine mesylate (pexeva) 413. fluoxetine Prozac) 414. sertraline (Zoloft) 415. escitalopram (Lexapro) 416. Monoamine oxidase inhibitors MAOIs - Correct phenelzine (nardil) 417. tranylcyprmie sulfate (parnate) 418. selegiline transdermal (EMSAM) 419. SNRIs and other agents - Correct trazodone (Desyrel) 420. venlafaxine (Effexor) 421. desvenlafaxine (Pristiq) 422. mirtazapine (Remeron) 423. nefazodone (serzone) 424. bupropion (Wellbutrin, Forfivo, Aplenzin) 425. duloxetine (Cymbalta) 426. vilazodone (viibryd) 427. vortioxetine (brintellix) 428. levomilnacipran (Fetzima) 429. Benzodiazepines BNZs - Correct lorazepam (Ativan) 430. clonazepam (klonopin) 431. chlordiazepoxide (Librium) 432. oxazepam (serax) 433. clorazepate (tranxene) 434. alprazolam (xanex) 435. anxiolytics - Correct buspirone (buspar) 436. other agents to tx anxiety dx - Correct propranolol (Inderal) 437. atenolol (Tenormin) 438. stimulants - Correct amphetamine/destroamphetamine (Adderall) 439. dexmethylphenidate (focalin) 440. dextroamphetamine (Dexedrine) 441. methylphenidate (Ritalin) 442. lisdexamfetamine dimesylate (Vyvanse) 443. other ADHD and ADD agents - Correct guanfacine (intuniv) 444. clonidine (kapvay) 445. atomoxetine (Strattera) 446. antidepressants such as desipramine (norpramin), venlafaxine (Effexor), and bupropion (Wellbutrin) are also used 447. schedule II drugs - Correct medicinal drugs in current use 448. high potential for abuse and dependency 449. written script only 450. no telephone orders 451. no refills on script 452. morphine sulfate, codeine, fentanyl, methadone, hydromorphone (dilaudid), oxycodone (oxycontin, Percocet), hydrocodone (Vicodin etc), amphetamine salts, methylphenidate 453. schedule III drugs - Correct medicinal drugs with less abuse than II 505. poppy seeds 506. meds that can cause false positives for methadone or PCP - Correct OTC cough meds (Nyquil) dextromethorphan 507. psychoanalytic therapy - Correct Freud 508. promotes change by development of greater insight and awareness of maladaptive defenses 509. Cognitive therapy - Correct Aaron Beck 510. goal is to change clients irrational beliefs, faulty conceptions, and negative cognitive distortions 511. behavioral therapy - Correct Arnold Lazarus 512. focus on changing maladaptive bx by participating in active bx techniques such as exposure, relaxation, problem solving, and role playing 513. Dialectical behavior therapy - Correct Marsha Linehan 514. focuses on emotional regulation, tolerance for distress, self management skills, interpersonal effectiveness, mindfulness, with an emphasis on treating therapy-interfering bx 515. goals of DBT - Correct decrease suicidal bx 516. decreased therapy interfering bx 517. decrease emotional reactivity 518. decrease self invalidation 519. decrease crisis-generating bx 520. decrease passivity 521. increase realistic decision making 522. increase accurate communication of emotions and competencies 523. existential therpay - Correct viktor frankl 524. goal to live authentically and to focus on the present and on personal responsibility 525. humanistic therpay - Correct carl rogers 526. person-centered therapy 527. self directed growth and self actualization 528. people are born with capacity to direct themselves toward self actualization 529. interpersonal therapy - Correct Gerald klerman and myrna Weissman 530. evidence based therapy focus on interpersonal issues creating distress 531. time limited, active, focus on the present and on interpersonal distress 532. eye movement desensitization and reprocessing EMDR - Correct Francine shapiro 533. behavioral and exposure therapy 534. PTSD 535. goal to achieve adaptive resolution 536. 3 phases of EMDR - Correct desensitization phase 537. installation phase 538. body scan 539. group phases - Correct pregroup phase 540. forming phase 541. storming phase 542. norming phase 543. performing phase 544. adjourning phase 545. family systems therapy - Correct Murray Brown 546. focus on chronic anxiety within families 547. tx goal to increase familys awareness of each members function within the family and to incrase levels of self determination 548. structural family therapy - Correct Salvador minuchin 549. main tx goal to produce structural change in the family organization to more effectively manage problems 550. changing transactional patterns and family structure 551. experiential therapy - Correct virginia satir 552. focus on being authentic, freedom of choice, human validation, and experiencing the moment 553. tx goals to develop authentic, nurturing communication and increased self worth of each family member 554. overall goal is growth rather than symptom reduction alone 555. does not focus on particular techniques 556. strategic therapy - Correct jay haley 557. tx goal to help family embers behave in ways that will not perpetuate the problem bx 558. interventions are problem focused 559. solution focused therapy - Correct steve deshaer bill ohanlon and insoo berg 560. focus to rework for the present situations that have worked previously 561. tx goal is effective resolution of problems through cognitive problem solving and use of personal resources and strengths 562. omega 3 fatty acid supplements - Correct used for ADHD, dyslexia, cognitive impairment, dementia, CVD, asthma, lupus, and rheumatoid arthritis 563. interacts with warfarin 564. Sam-e supplement - Correct used for depression, osteoarthritis, and liver dx 565. may cause hypomania, hyperactive muscle movements, and possible serotonin syndrome 566. tryptophan supplement - Correct used for depression, obesity, insomnia, headaches, and fibromyalgia 567. increased risk of serotonin syndrome with use of SSRIs, MAOIs, and st johns wort 568. vitamin E supplement - Correct used in enhancing immune system and protecting cells from effects of free radicals 569. used for neurological dx, diabetes, and PMS 570. interacts with warfarin, antiplatelet drugs, and statins increasing risk of rhabdomyolysis 571. melatonin supplement - Correct used for insomnia, jet lag, shift work, and cancer 609. DSM MDD diagnostic criteria - Correct -anhedonia or depressed mood or both 610. -depressed mood most of the day, nearly every day, as indicated by subjective reports or observations of others (irritability in kids) 611. -marked anhedonia in all or almost all ADLs 612. -at least 3 or more significant symptoms present during the same 2 week period that represent a change in previous functioning 613. -weight loss/gain of more than 5% of body weight 614. -hypersomnia or insomnia nearly every day 615. -psychomotor agitation or retardation 616. -fatigue or loss of energy 617. -self-deprecating comments or thoughts 618. -feelings of worthlessness or excessive or inappropriate guilt nearly every day 619. -decreased concentration and memory 620. -symptoms that begin within 2 months of significant loss and do not persist beyond 2 months is bereavement not MDD 621. SSRIs act on - Correct increasing serotonin levels 622. TCAs act on - Correct elevating serotonin and norepinephrine levels 623. MAOIs act on - Correct elevating serotonin and norepinephrine levels 624. SNRIs act on - Correct inhibiting dual reuptake of norepinephrine and serotonin 625. citalopram (celexa) - Correct -SSRI 626. -tablet 627. -20-40mg/day 628. -SE: sedation, sexual dysfunction, agitation, yawning, GI disturbances, wt gain 629. -preg C 630. -lact L2 631. -proglonged QTc interval in doses above 40mg (20mg in older adults) and in those susceptible to prolonged QTc 632. escitalopram (Lexapro) - Correct -SSRI 633. -tablet 634. -10-20mg/day 635. -SE: somnolence, headache, sexual dysfunction, GI disturbances 636. -prego C 637. -Lact L2 638. fluoxetine (Prozac) - Correct -SSRI 639. -capsule, tablet, or liquid 640. -20-80mg/day 641. -SE: insomnia, headache, GI disturbances, sexual dysfunction 642. -Long half-life 643. -Prego C 644. -Lact L2 645. -discontinuation syndrome unlikely 646. fluvoxamine (Luvox) - Correct -SSRI 647. -tablet 648. -100-300mg/day 649. -SE: sedation, sexual dysfunction, agitation, GI disturbances 650. -Doses above 150mg should generally be given BID 651. -Prego C 652. -Lact L2 653. Paroxetine (Paxil CR, Pexeva) - Correct -SSRI 654. -tablet or liquid 655. -20-60mg/day 656. -SE: headache, GI disturbances, somnolence, sexual dysfunction 657. -Prego D 658. -Lact L2 659. -Discontinuation syndrome very common 660. Sertraline (Zoloft) - Correct -SSRI 661. -tablet 662. -50-200mg/day 663. -SE: sexual dysfunction, GI disturbances, somnolence, headache 664. -Prego C 665. -Lact L2 666. Vilazodone (Viibryd) - Correct -Serotonin partial agonist reuptake inhibitor SPARI 667. -tablet 668. -20-40mg 669. -SE: diarrhea, nausea, dry mouth, lower risk of sexual side effects 670. -Prego C 671. -Lact unknown, is excreted in breast milk 672. Amitriptyline (Elavil) - Correct -TCA 673. -tablet or IM 674. -50-300mg/day 675. -also used for chronic pain (particularly neuropathic pain), insomnia 676. -Prego C 677. -Lact L2 678. clomipramine (Anafranil) - Correct -TCA 679. -Capsule 680. -100-250mg/day 681. -approved for OCD 682. -250mg/day maximum d/t increased seizure risk 683. -Prego C 684. -Lact L2 685. Desipramine (Norpramine) - Correct -TCA 686. -tablet or capsule 687. -100-300mg/day 688. -also used for ADHD (off label for pediatric clients and for ADHD) 689. -Prego C 690. -Lact L2 691. Doxepin (Sinequan) - Correct -TCA 692. -Capsule or liquid 693. -100-300mg/day 694. -also used for insomnia 754. TCA side effects - Correct -anticholinergic 755. -antiadrenergic 756. -antihistaminergic 757. -EKG changes and cardiac dyshrythmias possible 758. -unsafe in many co-occurring disorder such as cardiac disease 759. -significant discontinuation syndrome 760. anticholinergic side effects - Correct dry mouth 761. blurred vision 762. constipation 763. memory problems 764. from muscarinic receptor blockade 765. antiadrenergic side effects - Correct orthostatic hypothension from alpha 1 receptor blockade 766. antihistaminergic side effects - Correct sedation and weight gain from histamine receptor blockade 767. TCA serum blood levels - Correct well identified levels guide dosing 768. particularly nortriptyline 769. predicts toxicity 770. combo of TCAs and MAOIs - Correct lethal serotonin syndrome, hypertensive crisis, or both 771. adhere to two week washout period (5 weeks for fluoxetine) before switching between the two classes of medications 772. combo of TCA and SSRI - Correct use caution 773. SSRI can elevate TCA concentrations because of pharmacodynamic or pharmacokinetic interactions 774. monitor TCA levels 775. MAOIs - Correct not first or second line d/t dangerous food/drug interactions 776. MAOIS and tyramine - Correct hypertensive crisis 777. hypertensive crisis - Correct life threatening and cannot be reversed unless more MAO is produced by the body 778. sudden, explosive like headache, usually in occipital region 779. elevated BP 780. facial flushing 781. palpitations 782. pupillary dilation 783. diaphoresis 784. fever 785. Hypertensive crisis and death occurring when MAOIs taken in conjunction with certain meds - Correct meperidine 786. decongestants 787. TCAs 788. atypical antipsychotics 789. st johns wort 790. l-tryptophan 791. stimulants and other sympathomimetics 792. asthma meds 793. hypertensive crisis tx - Correct d/c MAOI 794. give phentolamine (binds with norepinephrine receptor sites, blocks norepinephrine) 795. -stabilize fever 796. Combo of MAOI and serotonergic agent - Correct contra d/t serotonin syndrome risk 797. Serotonin syndrome tx - Correct -d/c offending agents 798. -supportive tx of symptoms 799. mild symptoms such as restlessness may d/c with removal of agent, close monitoring and judicious use of benzos 800. -severe symptoms constitute a medical emergency necessitating hospitalization and tx such as cyproheptadine, anticonvulsants, and autonomic support 801. clinically significant side effects of MAOIs include - Correct insomnia 802. hypertensive crisis 803. weight gain 804. anticholinergic side effects 805. lightheadedness and dizziness 806. sexual dysfunction 807. Venlafaxine (Effexor, Effexor XR) - Correct -SNRI 808. -Capsule (XR), or tablet 809. -75-375mg/day 810. -XR 75-225mg/day 811. -SE: diaphoresis, headache, dizziness, GI disturbances 812. -can raise BP 813. -QD for XR capsules 814. -BID-TID dosing for tablets 815. -full SNRI effect at doses at or above 150mg 816. -safer in OD than TCAs 817. -has significant discontinuation syndrome of stopped abruptly 818. -Prego C 819. -Lact L3 820. Duloxetine (Cymbalta) - Correct -SNRI 821. -Capsule 822. -30-120mg/day 823. -SE: dizziness, headache, GI disturbances 824. -once daily dosing 825. -can elevate BP 826. -can elevate LFTs 827. -has significant discontinuation syndrome if stopped abruptly 828. -Prego C 829. -Lact L3 830. Vortioxetine (Brintellix) - Correct -5HT3 and 5HT7 antagonist 831. -5HT 1A agonist 832. -tablet 5, 10, 20mg 833. -20mg QD 834. -SE: nausea, diarrhea, dizziness 835. -Prego C 836. -Lact inadequate info 837. Levomilnacipran (Fetzima) - Correct -SNRI 838. -tablet 20, 40, 80, 120mg 839. -40-120mg QD 897. SSRIs 898. both 899. Bipolar biological theories - Correct -GABA deregulation 900. -increased noradrenergic activity 901. -voltage-gated ion channel abnormalities 902. -abnormalities lead to abnormal balances of intracellular and extracellular levels of neurotransmitters, which then cause subsequent disruption of electric signal transmission in brain regions 903. -kinding 904. kindling - Correct -process of neuronal membrane threshold sensitivity dysfunction 905. -long-lasting, epileptogenic changes induced by daily subthreshold brain stimulation 906. -brain becomes overly sensitive to electrical stimuli 907. -neuronal misfiring occurs 908. -process becomes automatic; neuronal firing occurs even without stimuli 909. Bipolar diagnostic criteria - Correct -period of abnormally or persistent elevated, expansive, or irritable mood lasting for at least 1 week 910. -mood episode has rapid development and escalation of symptoms over a few days 911. -often precipitated by significant environmental stressor 912. -mood disturbance may result in brief psychotic symptoms 913. -manic episodes last days to several months 914. -briefer duration and ending more abruptly tan major depressive episodes 915. -60% of people, a major depressive episode immediately precedes or follows a manic episode 916. -persistent symptoms of mania 917. -recurrent shifts on polarity 918. -expansive or elevated mood symptoms 919. Bipolar I - Correct clinical history characterized by occurrence of 1 or more manic or mixed episodes 920. Bipolar II - Correct -Clinical hx characterized by occurrences of one or more major depressive episodes accompanied by at least 1 manic or hypomanic episode 921. -recurrent shifts in polarity can occur more frequently-rapid cycling 922. rapid cycling - Correct -occurrence of 4 or more mood episodes during the previous 12 months 923. -mood episodes are either major depressive or manic 924. -other than occurring more frequently, mood episodes are same as nonrapid-cycling episodes 925. -20% of people 926. -most are women 927. -identification is important 928. -antidepressants may accelerate cycling 929. -poorer prognosis 930. mixed state - Correct dysphoric hypomania 931. lithium in BP - Correct -gold standard for manic episodes 932. -antisucidial effects 933. -action unknown 934. -rapid cycling rarely responds to monotherapy 935. baseline labs prior to lithium initiatin - Correct -Thyroid 936. -Serum creatinine 937. -BUN 938. -Prego 939. -ECG for pts over 50yo 940. endocrine SE of lithium - Correct weight gain 941. impaired thyroid functioning 942. CNS SE of lithium - Correct fine hand tremors 943. fatigue 944. mental cloudiness 945. headaches 946. coarse hand tremors with toxicity 947. nystagmus 948. derm SE of lithium - Correct maculopapular rash 949. pruritus 950. acne 951. GI SE of lithium - Correct GI upset 952. diarrhea 953. vomiting 954. cramps 955. anorexia 956. renal SE of lithium - Correct polyuria with related polydipsia 957. diabetes insipidus 958. edema 959. microscopic tubular changes 960. cardia SE of lithium - Correct T-wave inversions 961. dysrhythmias 962. hem SE of lithium - Correct leukocytosis 963. carbamazepine in BP - Correct -black box warning agranulocytosis and aplastic anemia 964. valproic acid/divalproex sodium in BP - Correct -black box warning for hepatotoxicity and pancreatitis 965. Lamotrigine in BP - Correct -black box warning for serious rash 966. Lithium carbonate (Eskalith, Lithobid) - Correct -1,200- 2,400mg/day (acute) 967. -900-1200mg/day (maintenance) 968. -SE: common- nausea, fine hand tremors, increased urination and thirst 969. -SE: toxicity- slurred speech, confusion, severe GI effect 970. -establish standard treatment for BP 971. -Prego D 972. -Lact L3 973. -risk of hypothyroidism 974. -avoid in prego, especially 1st trimester 975. -monitoring of kidney function is essential 1023. a daily mood chart 1024. cyclothymic disorder - Correct -chronic, fluctuating mood dx with symptoms similar but less severe than BP 1025. -numerous periods of hypomanic and dysthymic symptoms 1026. -often regarded by others as temperamental, moody, unpredictable, inconsistent, and unreliable 1027. -no psychotic episodes 1028. ataques de nervios - Correct -latino cultural syndrome 1029. -provoked by disruptions in family bonds 1030. -trembling, crying, screaming 1031. -in presence of others 1032. -relief after 1033. first line tx for children and teens with anxiety dx - Correct psychotherapy 1034. anxiety psychodynamic theory - Correct -freud 1035. -anxiety initially occurs in response to stimulation of birth and need of infant to adapt to changed environment 1036. -subsequent anxiety is from intrapsychic conflict 1037. -process of unconscious repression of sexual drive is at the core 1038. -conflict exists between instinctual needs of the id and the superego 1039. anxiety interpersonal theory - Correct -henry stack Sullivan 1040. -humans are goal directed toward attainment of satisfaction and security needs that are normally met in interpersonal interactions 1041. -anxiety is when needs are unmet 1042. -interpersonal conflict 1043. anxiety neurobiological theory - Correct -deficits in limbic system, midline brainstem area, sections of cortex 1044. -predispose to abnormal stress response, with hyperactivity of autonomic nervous system 1045. -problems with HPA axis 1046. -low levels of GABA 1047. neurotransmitters involved in suppressing the HPA axis - Correct Serotonin 1048. GABA 1049. First line agents for chronic anxiety disorders - Correct SSRIs 1050. acts on serotonin system and indirectly on GABA system 1051. Benzos - Correct -potentiate effect of GABA 1052. -use is associated with Alzheimers 1053. -longer half lives are more useful for continuous, moderate to severe anxiety or as bridge meds while waiting for efficacy of SSRI (klonopin, valium) 1054. -shorter half lives require more frequent dosing and have more severe withdrawal and rebound anxiety (xanex, Ativan) 1055. TCAs in anxiety - Correct effective but affect multiple receptors and have problematic side effect profiles 1056. Buspirone (Buspar) - Correct -20-60mg/day 1057. -SE: dizziness, insomnia, tremors, akathisia, stomach upset, dry mouth 1058. -helpful adjunct for anxiety 1059. -not PRN 1060. Tiagabine (Gabitril) - Correct -4-56mg/day 1061. -SE: dizziness, somnolence, stomach upset, tremors, dry mouth 1062. -helpful adjunct for anxiety 1063. , off label use 1064. Gabapentin (Neurontin) - Correct -300-3600mg/day 1065. -SE: ataxia, decreased coordination, sedation, disequilibrium 1066. -used for anxiety, neuropathic pain, fibromyalgia, and as an anti-craving medication 1067. -off label use 1068. Propranolol (Inderal) - Correct -10-20mg/day PRN 1069. -SE: bradycardia, hypotension 1070. -performance anxiety 1071. -off label use 1072. -usually adjunctive with other agent 1073. anxiety meds in children - Correct -alpha agonists often used 1074. -clonidine (catapres) 0.003-0.01mg/kg/day off label 1075. -guanfacine (tenex) 0.015-0.05mg/kg/day off label 1076. standardized rating scales for anxiety disorders - Correct - Zungs self rating anxiety scale 1077. -Hamilton rating scale for anxiety 1078. -yale-brown obsessive compulsive scale 1079. panic disorder diagnostic criteria - Correct -discrete episode in which client experiences 4 or more symptoms having a sudden onset and peaking within 10 minutes of onset 1080. -after 1st attack, persistent concern over having another attack, worry over the consequences of initial attack, or a significant bx change related to attack 1081. -with high somatic sensations, clients are often sensitive to new somatic experiences or perceptions 1082. -often intolerant of or concerned with common side effects of medication tx 1083. for panic disorder, consider general medical disorder if - Correct -first episode panic attack symptoms occur after 45yo 1084. -panic symptoms are atypical such as: vertigo, loss of consciousness, incontinence, headache, slurred speech, amnesic pattern after attacks 1085. Panic disorder pharm - Correct - SSRIs 1086. -Benzos for short term symptom control or bridge med when starting antidepressant 1087. -buspar effective adjunct to antidepressant 1088. -other non-benzo anxiolytic meds as adjuncts 1089. agoraphobia diagnostic criteria - Correct -presence of anxiety related to fear of developing panic-like symptoms 1090. -never met criteria for panic disorder 1091. -avoidant bx as a result of anxiety 1092. agoraphobia pharm - Correct -SSRIs 1093. -benzos for short term use 1137. -smaller frontal and temporal lobes 1138. -reduced symmetry in temporal, frontal, and occipital lobes 1139. -cortical atrophy 1140. -decreased cerebral blood flow 1141. -hippocampal and amygdala, thalamus reduction 1142. -widened cortical sulci 1143. -diffuse decrease in volume of white and gray matter 1144. schizophrenia neurochemical alterations - Correct -excess dopamine in mesolimbic pathway 1145. -decreased dopamine in mesocortical pathway 1146. -excess glutamate 1147. -decreased gama-aminobytyric acid (GABA) 1148. -decreased serotonin 1149. schizophrenia demographics men - Correct -onset 18-25 yo 1150. -tend to have more negative side effects 1151. -tend to have poorer prognosis, more hospitalizations, and less responsiveness to meds 1152. schizophrenia demographics in women - Correct -onset 25-35 years 1153. -usually less premorbid dysfunction than men 1154. -usually experience more dysphoria than men 1155. -tend to have paranoid delusions and more hallucinations than men 1156. Schizophrenia diagnostic criteria - Correct -2+ symptoms frequently present during 1 month period and at least 1 must be delusions, hallucinations, or disorganized speech 1157. -significant occupational/social impairment 1158. -duration at least 6 months 1159. what schizophrenia symptoms are most debilitating - Correct negative symptoms 1160. negative schizophrenia symptoms - Correct -less responsive to antipsychotics 1161. -better response to atypicals 1162. -caused by decrease dopamine in mesocortical pathway 1163. positive schizophrenia symptoms - Correct -respond well to antipsychotics 1164. -excess or distortions of normal brain functioning 1165. -caused by increased dopamine in mesolimbic pathway 1166. schizophrenia presence of neurological nonlocalizing soft signs - Correct -astereogonosis 1167. -twitches, tics, rapid eye blinking 1168. -dysdiadochokinesia a. impaired fine motor movement 1169. -left-right confusion 1170. -mirroring 1171. schizophrenia presence of neurological localizing hard signs - Correct -weakness 1172. -decreased reflexes 1173. schizophrenia brain abnormalities noted in functional studies - Correct -hypofrontality 1174. -decreased cerebral blood flow and metabolism 1175. -diffuse hypometabolic action in cortical-subcortical circuitry 1176. Clozapine (Clozaril) - Correct -SGA 1177. -tablet or ODT 1178. -25-900mg/day 1179. -SE: common- tachycardia, drowsiness, dizziness, hypersalivation (sialorrhea), weight gain, hyperlipidemia 1180. -SE: rare- agranulocytosis, myocarditis, neuroleptic malignant syndrome 1181. -only drug for tx-resistant schizophrenia 1182. -Clozapine REMS program 1183. -risk for neutropenia is monitored by the ANC 1184. -during 1st 6 months- weekly blood draw 1185. -during 2nd 6 months- biweekly blood draw 1186. -monthly blood draw thereafter 1187. -ANC levels less than 500- suspend drug 1188. -can be challenged if benefits outweigh risk 1189. -monitor myocarditis 1190. -dose-related sz risk 1191. -significant weight gain and diabetes risk 1192. -rare hyperprolactinemia 1193. -monitor wt. BMI, waist circumference 1194. -monitor serum lipids and glucose 1195. -assess family/personal hx CVD dx 1196. Quetiapine (Seroquel/XR) - Correct -SGA 1197. -tablet 1198. -50-800mg/day 1199. -SE: common- sedation, hypotension (orthostatic hypotension), weight gain 1200. -SE: rare- cataract formation 1201. -transient and asymptomatic elevated LFTs 1202. -monitor for cataracts 1203. -divided BID/TID 1204. -no prolactin elevation 1205. -monitor wt, BMI, AG, serum lipids/glucose 1206. -assess family/personal hx CVD dx 1207. olanzapine (Zyprexa, Zyprexa Zydis, Zyprexa Relprevv) - Correct -SGA 1208. -tablet, IM (acute); 5-20mg/day 1209. -IM (long); 150-405mg Q2-4 weeks 1210. -SE: acute- sedation, wt gain, hyperlipidemia, elevated glucose/LFTs/mild prolactin 1211. -SE: long acting- requires monitoring 3 hours post injection d/trisk of postinjection delirium sedation syndrome 1212. -significant wt gain 1213. -monitor BMI, AG, WT, serum lipids/glucose 1214. -assess family/personal hx CVD dx 1215. Risperidone (Risperdal, Risperdal Consta) - Correct -SGA 1216. -tablet, liquid, ODT; 2-8mg/day 1217. -Injectable; 25-50mg IM Q2 weeks 1218. -SE: hypotension, galactorrhea, nausea, insomnia 1219. -doses >6mg associated with higher incidence of EPS 1220. -less wt gain than Clozaril or Zyprexa 1221. -greatest prolactin elevation 1222. -monitor BMI, AG, WT, serum lipids/glucose 1223. -assess family/personal hx CVD dx 1285. -serotonin binds to 5HT2a heteroreceptors on dopamine neurons, thus further shutting off release of dopamine 1286. -dopamine release in the nigrostriatal, tuberoinfundibular, and mesocortical pathways is enhanced 1287. mesolimbic pathway - Correct SDAs block dopamine in this pathway, causing decreased positive symptoms 1288. mesocortical pathway - Correct -SDAs increase dopamine in this pathway, causing decreased negative syptoms 1289. akinesia - Correct absence of movement 1290. difficulty initiating motion 1291. subjective feeling of lack of motivation to move 1292. often mistaken for laziness or lack of interest 1293. nigrostraiatal pathway - Correct -dopamine has a reciprocal relationship with acetylcholine 1294. -when serotonin is blocked by the SDA, dopamine increases, therefore ACh decreased, which causes decrased EPSE (caused by increased ACh) 1295. Tuberonfundibular pathway - Correct -dopamine inhibits prolactin 1296. -the blockade of dopamine by SDAs cause prolactin to increase, causing galactorrhea and gynecomastia 1297. -hyperprolactinemia is associated with antipsychotics may cause sexual problems, galactorrhea, amenorrhea, gynecomastia, and bone demineralization in postmenopausal women not on estrogen 1298. typical antipsychotics MOA - Correct -useful for treating positive symptoms by blocking dopamine in mesolimbic pathway 1299. -can make negative symptoms worse by blocking dopamine in mesocortical pathway 1300. -therapeutic effect related primarily to D2 receptor blockade 1301. Clorpromaizne (Thorazine) - Correct -tablet, SR, liquid 1302. -50-2000mg/day 1303. -SE: high- sedation, hypotension 1304. -SE: moderate- EPSE, anticholinergic 1305. -allergic dermatitis 1306. -photosensitivity 1307. -ECG changes- QTc monitoring 1308. -FGA 1309. Mesoridazine (Serentil) - Correct -tablet, liquid, injection 1310. -100-400mg/day 1311. -SE: high anticholinergic, sedation, hypotension 1312. -SE: low EPSE 1313. -ECG changes- QTc monitoring 1314. -FGA 1315. Thioridazine (Mellaril) - Correct -tablet, liquid 1316. -50-800mg/day 1317. -SE: high- anticholinergic, sedation, hypotension, prolonged QT interval 1318. -SE: low- EPS 1319. -ECG changes, QTc monitoring 1320. -irreversible retinal pigmentation at doses >800mg/day 1321. -decreased libido 1322. -retrograde ejaculation 1323. -FGA 1324. Fluphenazine (Permitil, Prolixin) - Correct -tablet, liquid, injection 1325. -2-40mg/day, 12.5-75mg/IM Q2 weeks (deconate) 1326. -SE: very high- EPSE 1327. -SE: low- anticholinergic, sedation, hypotension 1328. -FGA 1329. Perphenazine (Trilafon) - Correct -tablet, liquid, injection 1330. -8/64mg/day 1331. -SE: high- EPSE 1332. -SE: low- anticholinergic, sedation, hypotension 1333. --FGA 1334. Trifluoperazine (Stelazine) - Correct -tablet, injection 1335. -5-80mg/day 1336. -SE- High- EPSE 1337. -SE- low- anticholinergic, sedation, hypotension 1338. -FGA 1339. Haloperidol (Haldol) - Correct -tablet, liquid, injection 1340. -2-40mg/day 1341. -50-300mg IM Qmonth (deconate) 1342. -SE: very high- EPSE 1343. -SE: high- anticholinergic, sedation 1344. -SE: low-hypotension 1345. -In older adults, monitor for oculogyric crisis and pneumonia 1346. -FGA 1347. Loxapine (Loxitane) - Correct -capsule, liquid 1348. -20-250mg/day 1349. -SE: high- EPSE 1350. -SE: moderate- sedation, hypotension 1351. -SE: low- anticholinergic 1352. -FGA 1353. Molindone (Moban) - Correct -tablet, liquid 1354. -50-225mg/day 1355. -SE: high- EPSE 1356. -SE: low- anticholinergic, hypotension 1357. -SE: very low- sedation 1358. -little or no weight gain 1359. -FGA 1360. Thiothixene (Navane) - Correct -Capsule, liquid, injection 1361. -5-60mg/day 1362. -SE: high- EPSE 1363. -SE: low- anticholinergic, sedation, hypotension 1364. -FGA 1365. hight potentcy FGAs - Correct -greater risk of EPSE 1366. -less risk of sedation and anticholinergic symptoms 1367. low potency FGAs - Correct -greater risk of sedation and anticholinergic side effects 1368. -less risk of EPSE 1422. -d/c antipsychotic meds 1423. -administration of Dantrolene (Dantrium) or bromocriptine (Parlodel) for antipsychotic induced dopamine receptor blockade 1424. -Acetaminophen (antipyretic) and cooling blanket for hyperthermia 1425. -IV hydration 1426. -Benzo for muscular rigidity (catatonic symptoms) 1427. Assertive Community tx (ACT) - Correct evidence based case management program for schizophrenia 1428. Illness management recovery (IMR) - Correct evidence based recovery program for schizophrenia 1429. schizophrenia older adult considerations - Correct -more women than men with rare late onset 1430. -although prodromal isolation, more often married 1431. -prognosis usually better, more responsive to meds d/t dominance of positive symptom cluster 1432. SGA black box warning - Correct -increase in mortality in older adults with dementia-related psychosis 1433. older adult schizophrenia risk factors - Correct - postmenopausal states 1434. -presence of human leukocyte antigen 1435. -positive family hx 1436. older adult schizophrenia symptoms - Correct -predominance of positive symptoms 1437. -high levels of persecutory delusions and hallucinations 1438. -lower levels of disorganized bx 1439. -preservation of social and occupational interest 1440. -fewer negative symptoms 1441. schizophrenia clinical outcome mesure standardized rating scales - Correct -positive and negative syndrome scale (PANNS) 1442. -brief psychiatric rating scale (BPRS) 1443. -scale for assessment of positive symptoms (SAPS) 1444. -scale for assessment of negative symptoms (SANS) 1445. schizophreniform dx - Correct -closely resembles schizophrenia 1446. -2 differences 1447. -Total duration of illness at least 1 month but less than 6 months including prodrome, active illness period, and residual symptom phase 1448. -does not require impaired social or occupational functioning for diagnosis, although may be present 1449. schizophreniform dx hx assess for the following - Correct -2 + of the following frequently present during a 1 month period (delusions, hallucinations, disorganized speech, grossly disorganized bx, presence of negative symptoms) 1450. -duration of symptoms for at lest 1 month but not longer than 6 months 1451. schizophreniform prognosis - Correct -1/3 recover completely within 6 months 1452. -2/3 develop schizophrenia or schizoaffective dx 1453. schizoaffective dx - Correct an uninterrupted period of illness in which the person experiences psychotic symptoms similar to those seen in schizophrenia as well as mood symptoms similar to MDD or BP 1454. schizoaffective dx hx assess for the following - Correct - symptoms of schizophrenia (2 + of the following frequently present during a 1 month period: delusions, hallucinations, disorganized speech, grossly disorganized bx, presence of negative symptoms but usually less severe than in those with schizophrenia) 1455. -symptoms of 1+ mood dx (MDD, manic episode, mixed-mood episode) 1456. -presence of delusions or hallucinations for at least 2 weeks in the absence of prominent mood symptoms 1457. 2 schizoaffective dx subtypes - Correct -depressive 1458. -bipolar 1459. delusional dx - Correct -presence of 1+ nonbizarre delusions lasting for at least 1 month 1460. -psychosocial functioning and daily bx not at all impaired except as they surround content of delusion 1461. -seldom any other symptoms; in rare cases may have hallucinations or mood disturbances 1462. delusional disorder prevalence and demographics - Correct - mean onset 40yo 1463. -men more likely to have paranoid delusions 1464. -women more likely to have delusions of erotomania 1465. delusional dx risk factors - Correct disorders of the limbic system and basal ganglia 1466. delusional dx hs assess for the following - Correct -presence of delusion (well organized and potentially believable) 1467. -any usual bx is explainable if content of delusion understood 1468. delusional dx subtypes - Correct -erotomanic (leads to obsessive bx such as surveillance or stalking) 1469. -grandiose 1470. -jealous (usually seen in men) 1471. -persecutory 1472. -somatic 1473. -mixed 1474. brief psychotic disorder - Correct disorder with sudden onset of psychotic symptoms lasting gat least 1 day but less than a month 1475. brief psychotic disorder incidence and demographics - Correct occurs more in younger clients (20-30yo) 1476. brief psychotic dx prognosis - Correct always returns to premorbid level of functioning 1477. shared psychotic disorder (Folie A Deux) - Correct characterized by development of a delusion in a client who has a close relationship with another person who already has a psychotic disorder with a prominent delusion 1525. Lewy body disease - Correct -caused by Lewy inclusion bodies in the cortex 1526. -presents with recurrent visual hallucinations 1527. -parkinson features (bradykinesia, cogwheel rigidity, tremor) 1528. -adversely react to antipsychotics 1529. dementia genetic loading - Correct autosomal dominant trait 1530. dementia memory impairment- immediate and intermediate - Correct -most prominent feature of dx 1531. -usually earliest symptom 1532. -produces multiple deficits in daily functioning (unable to learn new info, forgets past info, loses valuables, forgets daily activities such as eating and dressing, becomes easily lost, has other cog deficits such as impaired executive functioning) 1533. dementia instruments for assessing level of impairment - Correct -not in public domain (mini-mental state examination MMSE) 1534. -in public domain (Montreal cognitive assessment [MoCA], mini- cog, St Louis University Mental Status Examination [SLUMS]) 1535. dementia physical exam findings - Correct -Amaurosis fugax (unilateral transient vision loss, described as curtain over eye) 1536. -unilateral focal-motor weakness 1537. -asymmetrical reflexes 1538. dementia pharm management for cognitive symptoms - Correct -N-methyl D-aspartate glutamate receptor agonists 1539. -Cholinesterase inhibitors 1540. N-methyl D-aspartate glutamate receptor agonists in dementia tx - Correct -prevent overexcitation of glutamate receptors and stabilize the neurodegenerative process 1541. -Memantine (Namenda) 1542. Memantine (Namenda) - Correct -N-methyl D-aspartate glutamate receptor antagonist 1543. -10-20mg BID 1544. -moderate to severe alzheimers dementia 1545. -may slow degenerative process 1546. -promotes synaptic plasticity 1547. -may be used in combo with cholinesterase inhibitors 1548. -memantine/donepezil (Namzric) combo medication 1549. cholinesterase inhibitors in dementia - Correct -may be initiated for mild to mod Alzheimers dx 1550. -can lead to modest clinical improvement in some clients, with studies showing 2-3 point improvement in MSE testing 1551. -tx only symptoms, slow loss of function, and may improve agitated bx 1552. -do not prevent pathological progression of dx 1553. -not effective in severe, end-stage dx 1554. -should stop if SE, usually NV, develop 1555. -commonly used (Donepezil [Ariciept] and Rivastigmine tartrate [Exelon]) 1556. Donepezil (Aricept) in dementia - Correct -cholinesterase inhibitor 1557. -5-10mg/day 1558. -approved for mild, mod, and severe Alzheimers dx 1559. -SE: common- N/V, diarrhea, appetite and weight loss, abnormal dreams, insomnia, dizziness 1560. Rivastigmine tartrate (Exelon) in dementia - Correct - cholinesterase inhibitor 1561. -1.5-6mg BID 1562. -increase gradually to avoid nausea 1563. -indicated for mild-mod alzheimers disease and Parkinson's disease dementia 1564. -transdermal: 4.5, 9.5, 13.3mg/24 hour patch 1565. -retitrate if lapse in tx occurs 1566. dementia related depression tx - Correct -tx for 6-12 months then attempts to taper 1567. -depression may reoccur and need to be tx as a chronic condition 1568. -may have less depression as dementia progresses and they become less aware 1569. dementia lifespan considerations in children - Correct - diagnosis not applicable until ages 4-6yo when cognition can be fully assessed 1570. -dementia in children usually presents as deterioration in functioning 1571. TBI prevention in military personnel - Correct -mandatory post- deployment screening for all vets returning from combat 1572. TBI diagnostic and lab findings - Correct -conventional structural neuroimaging studies are typically normal in mild TBI 1573. TBI pharm management - Correct -no specific meds 1574. -tx-related symptoms 1575. -increased sensitivity to meds 1576. -low seizure threshold 1577. -start low and go slow 1578. TBI cognitive disorders pharm recommendations - Correct - methylphenidate (increase attention, processing speech, general cognitive function, learning, and memory) 1579. -dextroamphetamine (increase attention, processing speed) 1580. -bromocriptine (off label, possibly helpful in increasing executive function) 1581. -amantadine (off label, possibly helpful in increasing general cognitive function, attention, concentration) 1582. TBI nonpharm management - Correct -follow up for 1 year after anyone with TBI makes suicide attempt 1583. -treat vestibular dysfunction with PT to reduce dizziness 1584. -treat traumatic vision syndrome with OT, scanning and accommodation difficulties lead to headaches, irritability, and fatigue 1585. -treat memory impairment with OT to teach memory improvement skills 1586. mild TBI lifespan consideration - Correct -most achieve full recovery within 3 months 1587. -if residual symptoms continue, 80-85% will learn within 6 months 1621. clinical institute withdrawal assessment for alcohol (CIWAA) - Correct -used to determine likelihood for withdrawal and delirium tremens (DTs), which usually occur within 24-72 hours after cessation of alcohol 1622. -10 symptoms 1623. -each symptom graded on 0-7 point scale with exception of orientation and sensorium which are graded on a 0-4 point scale 1624. -the higher the total score (max 67), the more likely the person will experience severe withdrawal and DTs 1625. -0-9 absence or very mild withdrawal 1626. -10-15 mild withdrawal 1627. -16-20 moderate withdrawal 1628. -21-67 severe withdrawal and possible DTs 1629. 10 common alcohol withdrawal symptoms - Correct -n/v 1630. -tremors 1631. -proxysmal sweats 1632. -anxiety 1633. -agitaiton 1634. -tactile disturbances 1635. -auditory disturbances 1636. -visual disturbances 1637. -headaches 1638. -altered sensorium 1639. benzo pharm tx of acute withdrawal - Correct -mutliple daily doses of Benzos used according to a fixed schedule and gradually tapered down over several days (lorazepam [ativan], chlordiazepoxide [Librium], diazepam [valium], oxazepam [serax]) 1640. polytherapy in acute withdrawal - Correct -a newer approach that matches drugs required for safe and effective withdrawal with neurotransmitter deficits created by substance use 1641. -SSRIs 1642. -opioid antagonists nalmefene hydrochloride (Revex), naltrexone (revia), or naltrexone for ER injectable suspension [vivitrol] 1643. -N-methyl-D-aspartate (NMDA) agonists 1644. antiseizure meds in acute withdrawal - Correct -such as carbamazepine (tegretol) and valproic acid (depakene) 1645. -sometimes used to decrease seizure potential 1646. adrenergic meds in acute withdrawal - Correct -used to decrease blood pressure and pulse rate associated with withdrawal 1647. clinical management of craving - Correct -anticraving meds such as naltrexone (revia), acamprosate (campral), ondansetron (zofran), or buprenorphine (buprenex) 1648. aversion treatment pharm - Correct -disulfiram (Antabuse) 1649. -do not administer until person has been alcohol free for at least 12 hours 1650. -can elevate liver function tests, so monitor 1651. -may potentially induce mania in people with BP disorder 1652. general health maintenance for alcohol dependance - Correct - treat vitamin deficiencies such as thiamine, folic acid, and B-complex vitamins 1653. citalopram (celexa) for treating caving and maintaining sobriety - Correct SSRI 1654. Decreases desire 1655. disulfiram (antabuse) for treating caving and maintaining sobriety - Correct -aldehyde dehydrogenase inhibitor 1656. averson therapy 1657. naloxone (narcan) for treating caving and maintaining sobriety - Correct opioid antagonist, antidote 1658. blocks effects of opioids 1659. buprenorphine (buprenex) for treating caving and maintaining sobriety - Correct opioid partial agonist 1660. opioid antagonist 1661. agonist and antagonist, decreases cravings 1662. buprenorphine and naloxone (Suboxone) for treating caving and maintaining sobriety - Correct narcotic analgesic 1663. opioid agonist/antagonist 1664. methadone (dolophine) for treating caving and maintaining sobriety - Correct narcotic analgesic 1665. suppresses withdrawal 1666. nalmefene (Revex) for treating caving and maintaining sobriety - Correct opioid antagonist 1667. increases abstinence 1668. IM (revia; vivitrol) for treating caving and maintaining sobriety - Correct opioid antagonist 1669. increases abstinence 1670. acamprosate (campral) for treating caving and maintaining sobriety - Correct homotaurine 1671. decreases craving 1672. ego-syntonic personality - Correct comfortable 1673. ego-dystonic personality - Correct uncomfortable 1674. Cluster A personalities - Correct -odd, unusual, eccentric, asocial 1675. -paranoid personality disorder 1676. -schizoid personality disorder 1677. -schizotypal personality disorder 1678. cluster B personalities - Correct -dramatic, affective instability 1679. -antisocial personality disorder 1680. -borderline personality disorder 1681. -histrionic personality disorder 1682. -narcissistic personality disorder 1683. cluster C personalities - Correct -anxious 1684. -avoidant personality disorder 1685. -dependent personality disorder 1686. -obsessive-compulsive personality disorder 1687. psychodynamic theory of personality disorders - Correct -early separations problems 1688. -object relations theory 1747. -preoccupation with being criticized or rejected in social settings 1748. -view of self as socially inept, personally unappealing, or inferior 1749. -unusual reluctance to take personal risks or engage in new activities 1750. dependent personality disorder - Correct -difficulty making everyday decisions without excessive advise 1751. -needing others to assume responsibility for most areas of life 1752. -difficulty expressing disagreement 1753. -difficulty initiating projects by himself or herself 1754. -going to excessive lengths to obtain nurturing and support from others 1755. -urgent seeking of another relationship if a close relationship ends 1756. -unrealistic preoccupation with fears of being left alone 1757. obsessvie-compuslive personality disorder - Correct - preoccupation with details, rules, order, and organization 1758. -perfectionism that interferes with task completion 1759. -excessive devotion to work and productivity 1760. -overly conscientious, scrupulous, and inflexible on issues of morality 1761. -inability to discard worn-out or worthless objects 1762. -reluctance to delegate tasks or work with others 1763. -adoption of a miserly spending style toward self and others 1764. -rigidity and stubbornness 1765. personality disorder pharm management for impulsivity - Correct SSRIs 1766. anticonvulsant mood stabilizers 1767. personality disorder pharm management for affective instability - Correct SSRIs 1768. anticonvulsant mood stabilizers 1769. personality disorder pharm management for anxiety - Correct non-benzo anxiolytics 1770. SSRIs 1771. Benzos used with extreme caution 1772. personality disorder lifespan considerations - Correct -unusual for someone to be given a personality disorder diagnosis before ages 16-18 1773. -an exception is antisocial personality disorder, which is often observable by onset of puberty, however, diagnosis of antisocial personality disorder is not made until age 18 1774. though process and content age of understanding - Correct by age 4, children have some understanding of what is real or made up 1775. test recall in children - Correct test recall after 5 minutes in school age children show be able to remember 3 objects 1776. abstraction in children - Correct -children ages 12 and younger are not expected to have abstractive thought abilities 1777. -young children have concrete thinking 1778. ODD - Correct -an enduring pattern of angry or irritable mood and argumentative, defiant, or vindictive behavior lasting at least 6 months with at least 4 of the associated symptoms (loses temper, touchy or easily annoyed, angry or resentful, argues with authority, actively defies or refuses to comply with request or rules from authority figures, blames others, deliberately annoys others, spiteful or vindictive) 1779. nonpharm treatment for ODD - Correct -therapy is mainstay 1780. -evidence based treatment 1781. -child and parent problem-solving skills training 1782. -incredible years (group intervention) 1783. -parent-child interactional therapy (individual or family intervention) 1784. -adolescent transitions program (ATP; individual or family and group intervention) 1785. conduct disorder - Correct -a repetitive and persistent pattern of behavior in which the rights of others or societal norms or rules are violated a. the presence of at least 3 of the following criteria must be present in the past 12 months , with 1 in the past 6 months (aggression toward people or animals, destruction of property, deceit or theft, serious violation of rules) 1786. -child onset before age 10 or adolescent onset after age 10 1787. conduct disorder demographics - Correct -onset is earlier for boys 10-12 years than girls 16 years 1788. conduct disorder prevention - Correct secondary prevention is important in younger clients 1789. conduct disorder nonpharm management - Correct -behavior therapy is mainstay 1790. -individual therpay 1791. -family therapy 1792. conduct disorder lifespan consideratiosn - Correct may be diagnosed in clients ages 18+ if criteria for antisocial personality disorder are not met 1793. ADHD - Correct -a persistent pattern of inattention or hyperactivity, impulsivity, or both that interferes with functioning and development 1794. -inattention, 6+ of the following (fails to give attention to details, difficulty sustaining attention, does not listen when spoken to, does not follow through on instructions, disorganized, avoids or dislikes tasks requiring sustained mental effort, loses things, distracted, forgetful) 1795. -hyperactive and impulsive 6+ of the following (fidgets, leaves seat, runs or climbs, unable to engage in quiet activities, on the go, talks excessively, blurts out information, difficulty waiting turn, interrupts others) 1796. -several symptoms present before 12yo 1797. ADHD subtypes - Correct -inattentive type 1798. -hyperactive type 1799. -combined type 1800. ADHD polygenic neurobiological deficits - Correct - abnormalities of pronto-subcortical pathways in frontal cortex and basal ganglia 1855. ASD prevalence - Correct -imbalances of glutamate, serotonin, and GABA are thought to be implicated in causation 1856. -brain imaging studies of children revealed microscopic and macroscopic abnormalities of the amygdala, hippocampus, and cerabellum 1857. -decreased numbers of Purkinje cells in the cerebellum are thought to play a role in the development 1858. ASD incidence and demographics - Correct -onset on symptoms before age 3 1859. -about 10% of people with ASD also have a genetic or chromosomal conduction such as downs or fragile X 1860. ASD screening - Correct -screened for developmental delays at well-child visit 1861. -modified checklist for autism in toddlers M-CHAT 1862. -autism diagnostic observation schedule-generic ADOS-G 1863. -ages and stages questionnaires ASQ 1864. Rett syndrome - Correct -the development of specific deficits following a period of normal functioning after birth 1865. rett syndrome indicence and demographics - Correct -primarily in girls 1866. -usually associated with intellectual disability 1867. rett syndorme hx assessment - Correct -normal psychomotor development through the 1st 5 months after birth 1868. Rett syndrome associated features - Correct -seizures 1869. -stereotypic hand movements 1870. binge eating disorder - Correct -binging occurs at least 2 days weekly for 6 months 1871. neurobiological factors of eating disorders - Correct -decreased hypothalamic norepinephrine activation 1872. -dysfunction of lateral hypothalamus 1873. -decreased serotonin 1874. eating disorder prevention - Correct secondary prevention important in young clients 1875. bulimia nervosa - Correct -both binge eating and inappropriate compensatory behaviors occur at least twice weekly for 3 months 1876. anorexia nervosa physical exam findings - Correct -bradycardia 1877. -hypotension 1878. -ECG changes (inversion of t-waves, ST segment depression, prolonged QT interval) 1879. -peripheral edema 1880. -hypertrophy of salivary glands 1881. -russells sign 1882. bulimia nervosa physical exam findings - Correct -russells sign 1883. -hypertrophy of salivary glands 1884. -rectal prolapse 1885. anorexia nervosa lab changes - Correct -normochromic, normocytic anemia 1886. -leukopenia 1887. -neutropenia 1888. -anemia 1889. -thrombocytopenia 1890. -hypokalemia 1891. -hypomagnesemia 1892. -hypoglycemia 1893. -decreased LH and FSH 1894. bulimia nervosa lab changes - Correct -hypotension 1895. -bradycardia 1896. -hypokalemia 1897. -hyponatremia 1898. -hypochloremia 1899. -hypomagnesemia 1900. -metabolic acidosis or alkalosis 1901. -elevated serum amylase 1902. eating disorder pharm management - Correct -Fluoxetine FDA for bulimia nervosa 1903. -SSRIs and TCAs effective in reducing frequency of binging and purging 1904. intellectual disability - Correct -onset must occur before 18yo 1905. -based on adaptive functioning NOT IQ scores 1906. the most preventable cause of intellectual disability is what - Correct fetal alcohol syndrome 1907. fetal alcohol syndrome characteristics - Correct -epicanthal skin folds 1908. -low nasal bridge 1909. -short nose 1910. -indistinct philtrum 1911. -small head circumference 1912. -small eye openings 1913. -wide set eyes 1914. -thin upper lip 1915. intellectual disability physical exam findings - Correct -oblique eye folds 1916. -small, flattened skull 1917. -large tongue 1918. -broad hands with stumpy fingers 1919. -single transverse palm crease 1920. -high check bones 1921. -brushfield spots on iris 1922. -cryptorchidism 1923. -abnormal finger and toe prints 1924. -congenital cardiac defects 1925. -early dementia 1926. -hypothyroidism 1927. ADHD into adulthood - Correct -symptoms of inattention usually remain with a decrease in impulsive and hyperactive symptoms 1928. sleep can be measured by - Correct polysomnography 1971. -common SE: impaired memory, efficacy decreases over time, should not be used long term 1972. Zalplon (Sonata) for sleep dx - Correct -ultra short half life makes this particularly useful for initial or middle-phase insomnia 1973. Zolpidem (Ambien, Ambien CR) - Correct -short half life drugs 1974. -may affect person the next morning 1975. -must allow for 8 hours before planned awakening 1976. -give on empty stomach 1977. eszopiclone (Lunesta) - Correct -Intermediate acting agent 1978. Rozerem - Correct -melatonin receptor agonist 1979. Suvorexant (Belsomra) - Correct -orexin antagonist 1980. -suppresses wakefulness 1981. -must consider long half-life 1982. antidepressants for sleep dx - Correct -used for sedation properties 1983. -amitriptyline (Elavil), doxepin (Sinequan, Silenor); generally avoid in older adults 1984. -mirtazapine (Remeron) 1985. -Trazodone 1986. wake promoting agents for sleep dx - Correct --Armodafinil (Nuvigil) 1987. -indicated for daytime sleepiness associated with OSA 1988. sleep hygiene - Correct -avoid computer and other electronic devices for 1 hour before bedtime 1989. -never lie in bed for more than 15 minutes if not able to sleep 1990. -avoid late-in--the-day exercise intensive 1991. insomnia in children - Correct -most commonly related to stress 1992. -often have been poor sleepers since birth 1993. -pharm tx not recommended for most children 1994. The purpose of the American Nurses Association's Psychiatric- Mental Health Nursing: Scope and Standards of Practice is... - Correct Define the Role and actions for the NP 1995. Primary Prevention care practices are an essential aspect of the PMHNP role. Which is the best example of a primary prevention care strategy for community behavioral health? - Correct Parenting skills classes for pregnant adolescents (Information reduces incidence of disease) 1996. The trend in legal rulings on cases involving mental illness over the past 25 years has been too.. - Correct protect the persons's freedoms or rights when they are committed to a mental hospital 1997. Mr. Smithers, an involuntary hospitalized patient experiencing psychotic symptoms, refuses to take any of his ordered medication because he believes "Jesus Christ told me I am the prophet and must fast for a year". Your actions should be based on your knowledge of what? - Correct Psychiatric clients can refuse treatment 1998. which statement best reflects the different between nurse-client relationship and a social relationship? - Correct in the nurse-client relationship, the primary focus on on the client and the client's needs 1999. a community has an unusually high incidence of depression and drug use among the teenage population. the public health nurses decide to address the problem, in part, by modifying the environment and strengthening the capacities of families to prevent the development of new cases of depression and drug use. what is this an example of? - Correct primary prevention 2000. Mrs. Kemp is voluntarily admitted to the hospital. After 24 hours she states she wishes to leave because "this place can't help me." The best action that reflects the legal right of this client is - Correct explain that the client cannot leave until you can complete further assessment. 2001. (almost every state allows for a brief period of detainment to assess a client for dangerousness to self or others before allowing a client to leave a hospital setting, even if the admission was voluntary) 2002. in forming a therapeutic relationship with clients, the PMHNP must consider developing many characteristics that are known to be helpful in relationship-building. which is an essential part of building a therapeutic relationship? - Correct authenticity 2003. according to the DSM5, which is true - Correct a culturally expected response to a stressor is not a mental disorder 2004. Mrs. French has been in individual therapy for 3 months. She has shown much growth and improvement in her functioning and insight and is to discontinue services within the next few weeks. In the next session, after you discuss service termination, she suddenly begins to demonstrate the original symptoms that had brought her to treatment initially. She is now hesitant to discharge, wants to continue services and is displaying an increase in regressive defense mechanisms. The best explanation of Mrs. French's behaviors is - Correct a sign of normal resistance to termination seen in the termination phase of therapy 2005. a client is displaying low self-esteem, poor self-control, self- doubt, and a high level of dependancy. these behaviors indicate developmental failure of which stage of development? - Correct early childhood 2006. Mr. Thompson has been forgetful lately, for example, forgetting where he has placed his keys or what time appointments are scheduled, and he has stated that he thinks these are just random behaviors that have no particular meaning. Which Freudian-based psychodynamic principle assumes that all behavior and actions are purposeful? - Correct psychic determinism principle 2007. an example of a mature, healthy defense mechanisms is... - Correct suppression 2008. (the client channels conflicting energies into growth-promoting activities) 2009. Mr. Johnson is a 54-year-old client you have been seeing for several weeks in therapy. while discussing his current concerns of martial stress, he lies the floor and assumes the fetal position. this is 2026. in assessing a client, you ask him the meaning of the proverb "people who live in glass houses shouldn't throw stones". he replies "because it will break the windows". the correct interpretation of this finding is - Correct unable to interpret the finding without knowing the client's age 2027. (this is a normal thought process in children younger than 12yo) 2028. the pmhnp is planning to work with a client using an individual therapy model of care. during the first session, the client makes the following statement: "this is the third time my son has run away. I have grounded him, taken away his bike, even tried cutting off his allowance and confining him to his room. what should I do now?" the most therapeutic response for the PMHNP to make is.. - Correct "maybe that depends on what you are trying to accomplish" 2029. a client says to the pmhnp "some days life is just not worth it. all my wife and I ever do is fight and scream. things at home would be calmer and simpler if I just wasn't there anymore". the most therapeutic response for the PMHNP to make is - Correct tell me what you mean by "it would be simpler if you just weren't there anymore"? 2030. Mrs. Shea has come to the mental health center seeking treatment for depression. She has a history of a suicide attempt by overdose one month ago. she was started on imipramine (TCA) after that event but stopped taking the med one week later because it "did no good." The PMHNP meets with Mrs. Shea to plan care with her. What is the most appropriate initial action? - Correct asking mrs. shea how to help her 2031. in completing the pmhnp assessment for the mrs. shea, the most appropriate lab test for the PMHNP to order at this time is - Correct liver function tests 2032. a client comes into the clinic with a longstanding history of depression and chronic renal failure. he is on an antidepressant and a diuretic and complains of increased depression, mild confusion, irritability, and overall apathy from being too tired to do anything. the best initial PMHNP action at this time is - Correct order a comprehensive metabolic panel 2033. Sarah presents for her initial intake appointment with complaints of depression. She is being treated for HTN and asthma by her PCP. Knowing that certain medications may cause or exacerbate depression, you obtain a complete medication history. Which of the following medications is known to exacerbate or cause depression? - Correct propranolol d 2034. when treating older adults, you should keep in mind that they are more sensitive to issues of drug toxicity because of which reason? - Correct decreased protein binding 2035. which known teratogenic effects can be causes by the common psychotropic medications divalproex and lithium? - Correct divalproex-spina bifida 2036. lithium- Epstein anomoly 2037. the study of what the body does to the drug is called - Correct pharmacokinetics 2038. your client sam is being treated for panic disorder with agoraphobia. he currently is being prescribed paroxetine (Paxil CR, 37.5 mg QD) and clonazepam (Klonopin, 0.5mg QD, PRN). he has been on clonazepam for 2 years and admits to needing 4 pills to achieve the same effect that 1 pill initially produced. this is possibly an example of which process? - Correct tolerance 2039. why is group therapy beneficial? - Correct it is always time limited 2040. (it increases social skills, is cost-effective, and enables participants to acquire the curative factors) 2041. which is the best rationale for using CBT - Correct recognize and change his or her automatic thoughts 2042. when working with a dysfunctional family, you find that the father worries excessively and is resistant to change. you give him a paradoxical directive to worry extremely well for 1 hour per day, knowing that he will likely be noncompliant, and thus change will occur. with this technique, you are unison which time of therapy? - Correct strategic therapy 2043. what best describes homeostasis in a family system - Correct balance or stability that the family returns to despite its dysfunction 2044. In an attempt to bring the client toward the goal he or she is working on, you ask the client, "if a miracle were to happen tonight, while you slept, and you woke in the morning and the problem no longer existed, how would you know, and what would be different?" This technique is used in which type of therapy? - Correct solution focused therapy 2045. ms. Thomas has been diagnosed with MDD an dis placed on fluoxetine 20mg for her depression. for the PMHNP to effectively monitor her use of the medication, which action should be part of ongoing care. - Correct The use of a standardized rating scale of depression 2046. what is the best reason for considering the SSRI among the first-line drug choices for treating major depression - Correct safe use in suicidal overdose clients 2047. a 23 year old women is brought into the ER after attempting suicide by cutting her wrists. which nursing action by the PMHNP would be of highest priority initially. - Correct take her vital signs 2048. which intervention by the PMHNP for a person experiencing statue de nervosa demonstrates culturally informed care? - Correct offering brief supportive psychotherapy 2049. the PMHNP working at a student mental health clinic has now been working with a freshman student for several weeks. the PMHNP leans that the student considers himself shy. he tells the NP that he has always felt uncomfortable in social situations or when he has to do oral presentations in class. he had few friends up until senior year of high school when he discovered he could enjoy himself if he had a couple of drinks before going out. he has continued this pattern in college and now occasionally drinks 2 to 3 beers on weekends as well. according to the DSM 5, does this student have a mental according to public health principles, this is an example of what level of prevention. - Correct primary 2060. a client with bipolar I disorder presents to your PMHNP office for a follow up visit. during the visit the client informed you that he no longer wants to be treated with medication., and he does not have bipolar disorder, that was a misdiagnosis. he further informs you he stopped all his medication 2 months ago and is here to thank you for your care and tell you that he no longer needs follow up appointments. understanding the ethical conflict, you use which of the following ethical principles in working with this client? - Correct autonomy 2061. a new client reveals to the PMHNP that her boyfriend screams at her and has repeatedly slapped and pushed her in front of her 3 year old son. she goes on to say that the boyfriend has thrown things at her and on one occasion threw a glass of water at her and hit her son in the back. should the pmhnp report this to CPS? - Correct yes, the pmhnp has a duty to report 2062. which of the following is a function of the psychiatric interview - Correct identify the mental health needs of the client 2063. a 74 year old married women was referred to you by her pcp for a psych eval. she had a normal medical and neurological exam in the last 2 months. the client presents with her husband of 45 years who states "my wife is just not the same anymore, she is irritable and asks the same question several times, even though I've answered it many times. the client responds, oh Henry, you do the same thing, its just a normal part of getting older, and the kids think everything is fine. during the assessment you complete the MMSE and the client scores 18. as the pmhnp treating the client, you know the results of her MMSE indicate which level of cognitive impairment. - Correct moderate cognitive impairment 2064. Mini Mental Status Exam MMSE scoring - Correct -total score 30 2065. -25-30 questionable significant 2066. -20-25 mild impairment 2067. -10-20 moderate impairment 2068. -10 or lower severe impairment 2069. you are the pmhnp treating Tim, a 10 yo child for ADHD and social anxiety disorder. his mother presents with Tim for his scheduled individual therapy session. at the end of the session his mother says I need to take Tim to see his pediatrician and at the last visit I was told he needed some HPV shot. I don't know, he's a boy, why would he need that? what do you think? what is the pmhnps best response to her question? - Correct the CDC recommends the hpv vaccine for all boys and girls at age 10. hpv can cause cancer in both men and women, and the vaccine is effective in protecting against the virus. can you tell me your concerns about Tim getting this vaccine? 2070. as a pmhnp working in a crisis evaluation center, you are aware that the initial focus of crisis assessment is on what - Correct safety of the client and others 2071. when conducting a neurological exam on a client, the pmhnp asks the client to hold out her arms and stick out her tongue while assessing for tremors. which cranial nerve is being assessed? - Correct hypoglossal 2072. a 20 year old asian man who was recently diagnosed with schizophrenia comes to your office for a follow up appointment. during the assessment, he talks about his experience in the group home, thinking that the television is sending him messages through news anchors during the 10pm evening news. what symptom is the client describing - Correct ideas of reference 2073. you are working with a family: mother, father, and 2 biological children. sam, the father, is very rigid and controlling, which seems to be out of fear that something might happen to his family. he worries daily and it affects his family relationships. you give sam a paradoxical directive and instruct him to intensely worry about everything he can think of for 1 hour a day. using a paradoxical directive is part of which therapy? - Correct strategic 2074. as a pmhnp working in an output addiction clinic, you often refer your clients to community AA and NA meetings. using yalom's therapeutic factors, you are aware that peer-led groups can inspire and encourage other group participants. which therapeutic factor is instilled in AA and NA group members. - Correct hope 2075. which of the following client statements best describes imitative behavior as a therapeutic factor in group therapy? - Correct group members begin to model aspects of other members of the group and group leaders 2076. DBT draws on cognitive theory and behavioral theory, along with other theories. elements of behavioral therapy in DBT include what? - Correct skills training and exposure 2077. (DBT focuses on cogntiive and behavioral techniques, mindfulness including medication, and emotional regulation) 2078. DBT affirms dialectical thinking, which involves examining and discussing opposing ideas to find the truth. this philosophy is a supportive principle of DBT training. the central dialectical pattern emphasized in DBT involves the tension between - Correct radical acceptance and change 2079. (DBT emphasizes acceptance of current reality of what is and the ability to engage in personal change) 2080. Samantha is a 26 yo partnered woman who works full time as a teacher. she is in a long-term relationship with Mary and they are getting along well, and doing well financially. they have 2 children, ages 2 and 6. Samatha is seeing the pMHNP to address her concerns that she is feeling down and sad for no reason and states, I know my life is going well but I just dont feel happy. I have always worried a lot and have been sad most of my life. as a PMHNP trained in transactional analysis (TA), you understand that personality is multifaceted and wonder if which of the following is affecting her ability to experience happiness. - Correct she likely had a traumatic event in her childhood and her thoughts and feelings related to the event are locked together in her brain and cannot be accessed. 2081. (according to TA, when a person is traumatized the thoughts and feelings get tied tighter and the process of therapy is to unlock the two) 2082. you have been working within 54 yo man who has been treated for schizophrenia since age 19. he has limited social interactions,